Provider Demographics
NPI:1043611809
Name:LEE DENTAL
Entity Type:Organization
Organization Name:LEE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-712-9000
Mailing Address - Street 1:6351 PRESTON RD
Mailing Address - Street 2:#300
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6320
Mailing Address - Country:US
Mailing Address - Phone:972-712-9000
Mailing Address - Fax:972-712-1941
Practice Address - Street 1:6351 PRESTON RD
Practice Address - Street 2:#300
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-6320
Practice Address - Country:US
Practice Address - Phone:972-712-9000
Practice Address - Fax:972-712-1941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18285251K00000X
TX18959251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare